Minerva anestesiologica
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Minerva anestesiologica · Jun 2016
ReviewThe role of anesthesia in the prevention of postoperative delirium: a systematic review.
Postoperative delirium (POD) is defined as an acute neurologic insult characterized by changes in consciousness and cognition, altered perception and a fluctuating course. It leads to poor outcome and increased health care system costs. Considering its high incidence, up to 60%, and the lack of a first-choice treatment, prevention has become a priority. Our aim was to systematically review literature on POD prevention and to identify the role of anesthesia in this context. ⋯ Methodologically robust studies supporting strategies for preventing POD are still lacking. Based on our analysis, anesthesiologists should consider the intraoperative use of a depth of anesthesia monitor and the choice for a lighter sedation when possible. The administration of preventive medications should be considered very carefully. Considering the multifactorial nature of POD, however, the integration of effective preventive strategies into multidisciplinary programs is advisable and should be the target for future research.
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Minerva anestesiologica · Jun 2016
ReviewEffects of passive leg raising on microvascular venous compartment in critically ill patients.
Evidences supporting the use of intracranial pressure (ICP) monitoring after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim of our paper was to examine whether elevated intracranial pressure and ICP-derived variables predict mortality and functional outcomes after aSAH. ⋯ Elevated ICP was associated with higher mortality however absolute ICP values per se were not independent predictors of functional recovery. Variables derived from ICP monitoring are more accurate than ICP absolute values in predicting outcome. Given the absence of good quality data, additional large studies may help to better define the prognostic value of ICP after aSAH.
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Minerva anestesiologica · Jun 2016
ReviewEffects of passive leg raising on microvascular venous compartment in critically ill patients.
Evidences supporting the use of intracranial pressure (ICP) monitoring after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim of our paper was to examine whether elevated intracranial pressure and ICP-derived variables predict mortality and functional outcomes after aSAH. ⋯ Elevated ICP was associated with higher mortality however absolute ICP values per se were not independent predictors of functional recovery. Variables derived from ICP monitoring are more accurate than ICP absolute values in predicting outcome. Given the absence of good quality data, additional large studies may help to better define the prognostic value of ICP after aSAH.
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Minerva anestesiologica · May 2016
Review Meta AnalysisIntravenous immunoglobulin in septic shock: review of the mechanisms of action and meta-analysis of the clinical effectiveness.
Sepsis is characterized by a complex immune response. In this study we aimed to provide a review of the mechanisms of action of immunoglobulin (Ig) related to sepsis and an updated meta-analysis of the clinical effectiveness of the Ig use in septic patients. ⋯ Our study showed that the use of intravenous Ig therapy in adult septic patients may have a rationale and seems to be associated with a reduced mortality. Anyway, the treatment effect generally tended to be smaller or less consistent if considering only those studies that were deemed adequate on each indicator. So, the available evidence is not clearly sufficient to support the widespread use of Ig in the treatment of sepsis.
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Minerva anestesiologica · May 2016
Review Meta AnalysisRestrictive versus liberal transfusion strategy for red blood cell transfusion in critically ill patients and in patients with acute coronary syndrome: a systematic review, meta-analysis and trial sequential analysis.
The risks and benefits of transfusing critically ill patients continue to evoke controversy. Specifically, the critically ill patients with active ischemic cardiac disease continue to represent a "gray area" in the literature. ⋯ Restrictive strategy is at least as effective to liberal strategy in critically ill patients. Nevertheless, there is insufficient evidence to recommend a restrictive strategy for patients with acute coronary syndrome.